4种癌前病变筛查技术对宫颈癌筛查价值的Meta分析

Meta-analysis of the value of four precancerous lesions screening techniques for cervical cancer screening

目的运用循证学方法综合评估近10年肉眼观察法、Pap筛查、TCT及人乳头瘤病毒(HPV)筛查在宫颈癌诊断中的价值。方法计算机检索Pubmed、Cochrane、Web of Science、Embase、Medline、知网、中国生物数据库及医学文献数据库,通过诊断准确性研究质量评价工具(QUADAS-2)进行质量评价。采用随机效应模型合并分析灵敏度、特异度、阳性似然比、阴性似然比、诊断比值比及曲线下面积(AUC)。数据采用Stata 15. 0和Meta-Disc 1. 4软件进行统计分析。结果灵敏度合并值由高到低分别为HPV DNA筛查0. 94 [95%CI (0. 92~0. 96)]、TCT 0. 80 [95%CI (0. 75~0. 85)]、Pap筛查0. 72 [95%CI(0. 66~0. 77)]及肉眼观察法0. 50 [95%CI (0. 43~0. 57)];特异度由高到低分别为Pap筛查0. 97 [95%CI (0. 97~0. 98)]、肉眼观察法0. 93 [95%CI (0. 92~0. 94)]、HPV DNA筛查0. 90 [95%CI (0. 89~0. 91)]及TCT 0. 78 [95%CI (0. 76~0. 80)]。结论建议综合考虑技术成本和地区经济发展水平,选择适宜的宫颈癌筛查方案,尽最大可能满足我国妇女宫颈癌筛查的需求。

Objective Cervical cancer is the most common gynecological malignant tumor. Currently,screening for precancerous lesions is still in an important position in the prevention of cervical cancer. This study aims to use evidence-based methods to comprehensively assess the value of visual observation, Pap screening, TCT, and HPV screening in the diagnosis of cervical cancer in the past 10 years. Methods Computer searches Pubmed,Cochrane,Web of Science,Embase,Medline,How Net,Chinese biological database and medical literature database,and quality through the Quality Assessment of Diagnostic Accuracy Studies 2( QUADAS-2) Evaluation. The random effects model is used to combine sensitivity,specificity,positive likelihood ratio,negative likelihood ratio,diagnostic odds ratio,and area under curve( AUC). Data are statistically analyzed using Stata 15. 0 and Meta-Disc 1. 4 software. Results The sensitivity from high to low are HPV DNA screening 0. 94 [95% CI( 0. 92 ~ 0. 96) ],TCT 0. 80 [95% CI( 0. 75 ~ 0. 85) ],Pap screening 0. 72 [95%CI(0. 66 ~ 0. 77) ],and visual observation 0. 50 [95% CI( 0. 43 ~ 0. 57) ]. The specificity from high to low are Pap screening 0. 97[95% CI( 0. 97 ~ 0. 98) ],visual inspection 0. 93 [95% CI( 0. 92 ~ 0. 94) ],HPV DNA screening 0. 90 [95% CI( 0. 89 ~ 0. 91) ],TCT 0. 78 [95% CI( 0. 76 ~ 0. 80)]. Conclusion It is recommended to consider the technical cost and regional economic development level,and to select the appropriate cervical cancer screening program,trying to meet the needs of cervical cancer screening for women in China.